2024-BenefitsGuide-V14-Final

If you live in one of the following states, you may be eligible for assitance paying your employer health plan premiums. The following list of states is current as of July 31, 2024. Contact your state for more information on eligibility.

• Gain a new dependent as a result of marriage, birth, adoption, or placement for adoption. You must request enrollment within 30 days after the marriage, birth, adoption, or placement for adoption. • Lose Medicaid or Children’s Health Insurance Program (S-CHIP) coverage because you are no longer eligible. You must request enrollment within 60 days after the loss of such coverage. In addition, you may enroll in a Reliance Rewards medical plan if you become eligible for a state premium assistance program under Medicaid or S-CHIP. You must request enrollment within 60 days after you gain such coverage. WOMEN’S HEALTH AND CANCER RIGHTS ACT OF 1998 If you have had or are going to have a mastectomy, you may be entitled to certain benefits under the Women’s Health and Cancer Rights Act of 1998 (WHCRA). For individuals receiving mastectomy-related benefits, coverage will be provided in a manner determined in consultation with the attending physician and the patient, for: These benefits will be provided subject to the same deductibles and coinsurance applicable to other medical and surgical benefits provided under this plan. For deductibles and coinsurance information applicable to the plan in which you enroll, please refer to the plan descriptions. If you would like more information onWHCRA benefits, contact Reliance Rewards at reliancerewards@rsac.com. NEWBORNS’ ANDMOTHERS’ HEALTH PROTECTION ACT NOTICE Group health plans and health insurance issuers generally may not, under Federal law, restrict benefits for any hospital length of stay in connection with childbirth for the mother or newborn child to less than 48 hours following a vaginal delivery, or less than 96 hours following a cesarean section. However, Federal law generally does not prohibit the mother’s or newborn’s attending provider, after consulting with the mother, from discharging the mother or her newborn earlier than 48 hours (or 96 hours as applicable). In any case, plans and issuers may not, under Federal law, require that a provider obtain authorization from the plan or the insurance issuer for prescribing a length of stay not in excess of 48 hours (or 96 hours). If you would like more information on maternity benefits, call Reliance Rewards at 855-777-9273. CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT (COBRA) If you’re an employee with medical, dental or vision coverage through Reliance Rewards, you have the right to choose continuation coverage if you lose your group health coverage due to a reduction in your hours of employment or the termination of your employment for reasons other than gross misconduct. Your eligible dependents may also have the right to elect and pay for continuation of coverage for a temporary period in certain circumstances where coverage under the plan would otherwise end, such as divorce, or dependent children who no longer meet eligibility requirements. Important note: This brief summary of the right you and your dependents have to continue insurance is not intended as the official notice of your rights required by federal and state law. We’ve included this brief summary to inform you that you have these rights. You’ll receive a separate, detailed explanation of your right to continue health insurance coverage when applicable. Specific information is also available from your HR representative. PREMIUM ASSISTANCE UNDERMEDICAID AND THE CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP) If you or your children are eligible for Medicaid or CHIP and you’re eligible for health coverage from your employer, your state may have a premium assistance program that can help pay for coverage, using funds from their Medicaid or CHIP programs. If you or your children aren’t eligible for Medicaid or CHIP, you won’t be eligible for these premium assistance programs, but you may be able to buy individual insurance coverage through the Health Insurance Marketplace. For more information, visit www.healthcare.gov. If you or your dependents are already enrolled in Medicaid or CHIP and you live in a State listed below, contact your State Medicaid or CHIP office to find out if premium assistance is available. If you or your dependents are NOT currently enrolled in Medicaid or CHIP, and you think you or any of your dependents might be eligible for either of these programs, contact your State Medicaid or CHIP office or dial 1-877- KIDS NOW or www.insuredkidsnow.gov to find out how to apply. If you qualify, ask your state if it has a program that might help you pay the premiums for an employer-sponsored plan. If you or your dependents are eligible for premium assistance under Medicaid or CHIP, as well as eligible under your employer plan, your employer must allow you to enroll in your employer plan if you aren’t already enrolled. This is called a “special enrollment” opportunity, and you must request coverage within 60 days of being determined eligible for premium assistance. If you have questions about enrolling in your employer plan, contact the Department of Labor at www.askebsa.dol.gov or call 866-444-EBSA (3272). • All stages of reconstruction of the breast on which the mastectomy was performed; • Surgery and reconstruction of the other breast to produce a symmetrical appearance; • Prostheses; and • Treatment of physical complications of the mastectomy, including lymphedemas.

ALABAMA – Medicaid Website: https://www.myalhipp.com/ Phone: 855-692-5447

IOWA – Medicaid and CHIP (Hawki) Medicaid Website: https://dhs.iowa.gov/ime/members Medicaid Phone: 800-438-4479 Hawki Website: https://dhs.iowa.gov/Hawki Phone: 800-257-8563 HIPP Website: https://dhs.iowa.gov/ime/members/medicaid-a-to-z/hipp HIPP Phone: 888-346-9562

ALASKA – Medicaid The AK Health Insurance Premium Payment Program Website: https://www.myakhipp.com/ Phone: 866-251-4861 Email: customerservice@myakhipp.com Medicaid Eligibility: https://dhss.alaska.gov/dpa/pages/ medicaid/default.aspx

KANSAS – Medicaid Website: https://kancare.ks.gov Phone: 800-792-4884

ARKANSAS – Medicaid Website: https://www.myarhipp.com/ Phone: 855-MyARHIPP (855-692-7447)

KENTUCKY – Medicaid Kentucky Integrated Health Insurance Premium Payment Program (KI-HIPP) Website: https://chfs.ky.gov/agencies/dms/member/ Pages/kihipp.aspx Phone: 855-459-6328 Email: kihipp.program@ky.gov KCHIP Website: https://kidshealth.ky.gov/Pages/index.aspx Kentucky Medicaid Website: https://chfs.ky.gov

CALIFORNIA – Medicaid Website: http://www.dhcs.ca.gov/services/Pages/

TPLRD_CAU_cont.aspx Phone: 916-440-5676 Fax: 916-440-5676 Email: hipp@dhcs.ca.gov

LOUISIANA – Medicaid Website: https://ldh.la.gov/subhome/1 or https://www.ldh.la.gov/lahipp Phone: 888-342-6207 (Medicaid hotline) or 855-618-5488 (LaHIPP)

COLORADO – Health First Colorado (Colorado’s Medicaid Program) & Child Health Plan Plus (CHP+) Health First Colorado Website: https://www.healthfirstcolorado.com Health First Colorado Member Contact Center Phone: 800-221-3943/State Relay 711 CHP+ Website: https://www.hcpf.colorado.gov/pacific/hcpf/ child-health-plan-plus Customer Service: 800-359-1991/State Relay 711 Health Insurance Buy-In Program (HIBI): www.mycohibi.com HIBI Customer Service: 855-692-6442 FLORIDA – Medicaid Website: https://www.flmedicaidtplrecovery.com/ flmedicaidtplrecovery.com/hipp/index.html Phone: 877-357-3268 GEORGIA – Medicaid Website: https://medicaid.georgia.gov/health-insurance- premium-payment-program-hipp GA CHIPRA website: https://medicaid.georgia.gov/programs/ third-party-liability/childrens-health-insurance-program-

MAINE – Medicaid Website: https://www.maine.gov/dhhs/ofi/applications-forms Phone: 800-442-6003 TTY: Maine relay 711 Private Health Insurance PremiumWebpage: https://www.maine.gov/dhhs/ofi/applications-forms

Phone: 800-977-6740 TTY: Maine relay 711

MASSACHUSETTS – Medicaid and CHIP Website: https://www.mass.gov/info-details/masshealth-

premium-assistance-pa Phone: 800-862-4840

MINNESOTA – Medicaid Website: https://mn.gov/dhs/people-we-serve/children-and- families/health-care/health-care-programs/programs-and- services/other-insurance.jsp Phone: 800-657-3739 MISSOURI – Medicaid Website: https://dss.mo.gov/mhd/participants/pages/hipp.htm Phone: 573-751-2005 MONTANA – Medicaid Website: https://dphhs.mt.gov/MontanaHealthcarePrograms/HIPP Phone: 800-694-3084

reauthorization-act-2009-chipra Phone: 678-564-1162, Ext. 2131

INDIANA – Medicaid Healthy Indiana Plan for low-income adults 19-64 Website: https://www.in.gov/fssa/hip/ Phone: 877-438-4479 All other Medicaid Website: https://www.in.gov/medicaid/ Phone: 800-457-4584

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